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A randomized controlled trial comparing the Thompson hemiarthroplasty with the Exeter polished tapered stem and Unitrax modular head in the treatment of displaced intracapsular fractures of the hip.

Abstract Aims This study aimed to compare the change in health-related quality of life of patients receiving a traditional cemented monoblock Thompson hemiarthroplasty compared with a modern cemented modular polished-taper stemmed hemiarthroplasty for displaced intracapsular hip fractures. Patients and Methods This was a pragmatic, multicentre, multisurgeon, two-arm, parallel group, randomized standard-of-care controlled trial. It was embedded within the WHiTE Comprehensive Cohort Study. The sample size was 964 patients. The setting was five National Health Service Trauma Hospitals in England. A total of 964 patients over 60 years of age who required hemiarthroplasty of the hip between February 2015 and March 2016 were included. A standardized measure of health outcome, the EuroQol (EQ-5D-5L) questionnaire, was carried out on admission and at four months following the operation. Results Of the 964 patients enrolled, 482 died or were lost to follow-up (50%). No significant differences were noted in EQ-5D between groups, with a mean difference at four months of 0.037 in favour of the Exeter/Unitrax implant (95% confidence interval (CI) 0.014 to 0.087, p = 0.156), rising to 0.045 (95% CI 0.007 to 0.098, p = 0.09) when patients who died were excluded. The minimum clinically important difference for EQ-5D-5L used in this study is 0.08, therefore any benefit between implants is unlikely to be noticeable to the patient. There was no difference in mortality or mobility score. Conclusion Allowing for the high rate of loss to follow-up, the use of the traditional Thompson hemiarthroplasty in the treatment of the displaced intracapsular hip fracture shows no difference in health outcome when compared with a modern cemented hemiarthroplasty. Cite this article: Bone Joint J 2018;100-B:352-60.
PMID
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Authors

Mayor MeshTerms
Keywords

Exeter

Femoral neck

Fracture

Hemiarthroplasty

Hip

Polished stem

Randomized controlled trial

Thompson

Unitrax

Journal Title the bone & joint journal
Publication Year Start




PMID- 29589786
OWN - NLM
STAT- In-Process
LR  - 20180328
IS  - 2049-4408 (Electronic)
IS  - 2049-4394 (Linking)
VI  - 100-B
IP  - 3
DP  - 2018 Mar 1
TI  - A randomized controlled trial comparing the Thompson hemiarthroplasty with the
      Exeter polished tapered stem and Unitrax modular head in the treatment of
      displaced intracapsular fractures of the hip.
PG  - 352-360
LID - 10.1302/0301-620X.100B3.BJJ-2017-0872.R2 [doi]
AB  - Aims This study aimed to compare the change in health-related quality of life of 
      patients receiving a traditional cemented monoblock Thompson hemiarthroplasty
      compared with a modern cemented modular polished-taper stemmed hemiarthroplasty
      for displaced intracapsular hip fractures. Patients and Methods This was a
      pragmatic, multicentre, multisurgeon, two-arm, parallel group, randomized
      standard-of-care controlled trial. It was embedded within the WHiTE Comprehensive
      Cohort Study. The sample size was 964 patients. The setting was five National
      Health Service Trauma Hospitals in England. A total of 964 patients over 60 years
      of age who required hemiarthroplasty of the hip between February 2015 and March
      2016 were included. A standardized measure of health outcome, the EuroQol
      (EQ-5D-5L) questionnaire, was carried out on admission and at four months
      following the operation. Results Of the 964 patients enrolled, 482 died or were
      lost to follow-up (50%). No significant differences were noted in EQ-5D between
      groups, with a mean difference at four months of 0.037 in favour of the
      Exeter/Unitrax implant (95% confidence interval (CI) 0.014 to 0.087, p = 0.156), 
      rising to 0.045 (95% CI 0.007 to 0.098, p = 0.09) when patients who died were
      excluded. The minimum clinically important difference for EQ-5D-5L used in this
      study is 0.08, therefore any benefit between implants is unlikely to be
      noticeable to the patient. There was no difference in mortality or mobility
      score. Conclusion Allowing for the high rate of loss to follow-up, the use of the
      traditional Thompson hemiarthroplasty in the treatment of the displaced
      intracapsular hip fracture shows no difference in health outcome when compared
      with a modern cemented hemiarthroplasty. Cite this article: Bone Joint J
      2018;100-B:352-60.
FAU - Sims, A L
AU  - Sims AL
AD  - Health Education North East, Waterfront, 4 Goldcrest Way, Newburn Riverside,
      Newcastle Upon Tyne, NE15 8NY, UK.
FAU - Parsons, N
AU  - Parsons N
AD  - Statistics and Epidemiology, Warwick Medical School, University of Warwick,
      Coventry CV4 7AL, UK.
FAU - Achten, J
AU  - Achten J
AD  - Department of Orthopaedic Trauma, Oxford Trauma, University of Oxford, Kadoorie
      Centre, Level 3, John Radcliffe Hospital, Oxford, OX3 9DU, UK.
FAU - Griffin, X L
AU  - Griffin XL
AD  - Oxford University Hospitals NHS Foundation Trust, Headley Way, Oxford and Oxford 
      Trauma, Nuffield Department of Rheumatology, Orthopaedics and Musculoskeletal
      Science, University of Oxford, OX3 9DU, UK.
FAU - Costa, M L
AU  - Costa ML
AD  - NDORMS, Oxford Trauma, Kadoorie Centre, University of Oxford, John Radcliffe
      Hospital, Windmill Road, Oxford, OX3 9DU, UK.
FAU - Reed, M R
AU  - Reed MR
AD  - Northumbria Healthcare NHS Foundation Trust, Woodhorn Lane, NE63 9JJ, UK.
LA  - eng
PT  - Journal Article
PL  - England
TA  - Bone Joint J
JT  - The bone & joint journal
JID - 101599229
OTO - NOTNLM
OT  - Exeter
OT  - Femoral neck
OT  - Fracture
OT  - Hemiarthroplasty
OT  - Hip
OT  - Polished stem
OT  - Randomized controlled trial
OT  - Thompson
OT  - Unitrax
EDAT- 2018/03/29 06:00
MHDA- 2018/03/29 06:00
CRDT- 2018/03/29 06:00
PHST- 2018/03/29 06:00 [entrez]
PHST- 2018/03/29 06:00 [pubmed]
PHST- 2018/03/29 06:00 [medline]
AID - 10.1302/0301-620X.100B3.BJJ-2017-0872.R2 [doi]
PST - ppublish
SO  - Bone Joint J. 2018 Mar 1;100-B(3):352-360. doi:
      10.1302/0301-620X.100B3.BJJ-2017-0872.R2.